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Minutes 03/09/1983 AGENDA EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL Meeting of March 9 , 1983 I . Roll Call II . Reading and/or approval of minutes a ) Regular meeting of February 10 , 1983 III . Advisors Reports IV . Old Business V . New Business VI . Adjourn /bm Naples , Florida March 9 , 1983 LET IT BE REMEMBERED, that the Emergency Medical Services Advisory Council met on this date at 4 :00 P .M. in Room 144 , Bldg "F" or the Courthouse Complex with the following members as indicated below: CHAIRMAN: Egon Hill MEMBERS : Dr. Hanns Erhardt Sgt. Richard Davidson (Excused) Chief Jim Billman (Excused) David Graham Marvin Cecil W. H. "Biff" Comte Richard Akin (Excused) Jonathan Smelko Wm. Shaughnessy EX-OFFICIO MEMBERS : Chief Norris Ijams E. G. Whidden for (Excused) Sheriff Rogers STAFF ADVISORS : Ann Foster Douglas Greenfield W. Neil Dorrill Dr Robert Tober (Absent) ALSO PRESENT: Sharon Aragona, for Richard Akin, "Skip" Camp, EMS, Jack Wampler, EMS Billings, Wm. Beschen, Rich Gibbons, and Billie Moyer. AGENDA I . Roll Call II . Reading and/or approval of minutes a) Regular meeting of February 10 , 1983 III . Advisors Reports IV. Old Business V. New Business VI . Adjourn EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 MINUTES APPROVED There being no additions or deletions, the Minutes of the meeting of the Emergency Medical Services Advisory Council held on February 10, 1983 were approved as submitted. ADVISORS REPORTS Mr. Dorrill reported he had received a request from the owner of Ambassador Airlines, Inc. to recommend that the Board of County Commissioners extend his Air-Ambulance Certificate of Need and Necessity for one year . Explaining that since the Certificate was provided them last October the State (HRS) had changed their rules regarding air-ambulance licensure and EMS activities in general making their State Certificate good for 2 years, instead of the one year period provided by the County. Mr. Dorrill further explained that the $250 . fee has already been paid and that it was simply a matter of extending the license renewal date from September 1983 to September of 1984 , without any additional cost, and said he felt it would be prudent to ask the Council to act on this request today. Mr. Graham made a motion to go along with the request. Motion seconded. Dr. Ehrhardt felt the Council should not get involved at all because they had been "passed by" in the first place . Mr. Hill did not agree, stating he saw no objection to going before the Board and asking that this request be granted. The motion was passed by a majority. DR. JAMES MELI CONSIDERED FOR NEXT ,VACANCY: Mr . Dorrill introduced a letter for the record written by Dr . Cox - 2 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9 , 1983 recommending that Dr. James Meil, Chief of Clinics of Collier County, be considered for the next vacancy on the EMSAC. Mr. Hill said he had contacted Dr. Meli, who is going to send his resume to Grace Spaulding and it will be up to the Commissioners to do the rest. LEGISLATIVE WORKSHOP/ISSUES ADDRESSED: Doug Greenfield reported on the issues addressed at the Florida Association of County Medical Services Special Legislative Workshop held in Clearwater which he had attended on February 24-25 . The items discussed were: 1 . Confidentiality of Trip Records - (generated after each call) 2. EVOC Driving Program - (introduced by legislature in 1982 as a requirement for EMS certification) 3 . Non-emergency Transportation - "Who Wants it?" 4 . Air-ambulances - "What is it and are Separate Laws Needed?" 5 . EMS Funding Bill - (resurrection of the Panhandle Bill) "Should This be Continued?" 6 . High-Hazard Pay for EMT' s and Paramedics 7 . Urban Hospitals - (overcrowded, overworked, with indigent care hospital-patient problem being experienced in some of the larger urban areas . Some hospitals are not accepting indigent patients) 8 . DPR vs HRS vs the Insurance Commissioners - "The Battle Begins" Mr. Hill asked what the Panhandle Bill is and Mr . Greenfield explained about the EMS Trust Fund which is monies collected from fines on all moving violations - DWI , speeding, etc . , which is gathered up annually and distributed back to the counties and earmarked for EMS from which a certain amount was to be used for research. Doug said that the first concept of the bill was good but that it was defeated because people could not agree on how to split the money or how the research was going to be done. Everyone felt individual entities didn 't have enough opportunity for 'input at the legislative level on this bill - no one really knows what happened to it and why it died - 3 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 he said, but the HRS Chairman is aware of it and tried to get it reintroduced into legislation this year . Mr. Hill asked how far it went last year and Doug replied that it hadn 't even made it out of the House. He went on to say that State Representative Elaine Gordon, one of the spearheads who was behind the move to put the certification and licensing program under DPR, had for some reason dropped out of the picture, which he believed might prove to be in our favor down the road. CONFIDENTIALITY OF TRIP RECORDS : Doug pointed out that every locality has different ways of dealing with this problem and said that government based systems feel that the Sunshine Law allows the media to go through patient records on transports any time they chose, which sometimes reveals quite sensitive information, such as in cases involving a homocide or potential for litigation for a malpractice suit. He said he had examined some of the alternatives and will have to meet with the County Attorney and decide how to handle them. He spoke of the "fine line" between privileged information, which belongs to the physician and patient, and of the governmental or public information concerning the actual agencies and their activities . Mr. Hill asked Neil Dorrill to discuss this with the County Attorney. Giving an example of one of the complexities which occurs , Doug explained that a paramedic, in his pre-diagnosis upon observation, will put down what he first encounters and thinks he sees . If a person appears to be intoxicated, he might put down "patient apparently ETOH, alcohol on breath, etc . Yet, this patient may not have been intoxi- - 4 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 cated, and information such as this when released to the media in the early investigative stages of a court case will result in the patient being convicted by the media and the public before it ever gets a chance to go to trial, adding that this can be far expanded in the case of a malpractice suit. Mr . Graham pointed out that even so, since this is a County operation, these are public records. Mr. Greenfield agreed, but said this was true only insofar as response time and address information was concerned, and that the personabl patient encounter information is where the fine line has to be drawn. He said he had tried to set up our trip tickets where the bottom copy, on which the paramedic makes his analysis, is actually a patient chart form which is given to the hospital, and a section providing response time, patient address, etc . can be cut off and given to the media. EVOC COURSE: Describing the EVOC driving school as a 40-hr course, having 16 hrs of class and an additional 24-26 hrs of field clinical time behind the wheel in all kinds of fabricated situations and being taught by specialized instructors, Mr . Greenfield said this program, if mandated by the State this year, would be very expensive. It would mean that every person who gets behind the wheel of an ambu- lance or is capable of getting behind the wheel of an ambulance, in- cluding every firefighter and firefighter EMT in the County who might at some time get behind the wheel of one of our units to get to the hospital would be required to take the course . Among the 33 counties represented, the consensus was that none were having problems with their systems concerning the need for more - 5 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 advanced driving skills. When asked who was sponsoring the bill and why it was so important to have a 40 hr program, the new Director of HRS could not answer. It was agreed that we would ask legislature to curtail this commitment for at least one more year and study what the needs are that require a 40 hr program. It was suggested that a more moderate program such as a 16 hr program - 8 hrs class and 8 hrs clinical - be developed to meet the needs of the community served, with EMS in Tallahassee setting up the guidelines developing the standards to meet driving certification requirements . Mr. Greenfield added that Tallahassee wants each locality to be responsible for certification of their own drivers and seeing that all standards are met, including carrying of an identification card at all times so it is available for inspectors when they come around. Mr. Hill asked what the requirements were for qualification as driver in the City of Naples Fire Department. Chief Ijams said that each takes an annual defensive driving course which he feels is ade- quate. He recalled that the State had instigated programs in the past with the idea that they would fund them, but they did not and it became the obligation of the local government. He added that the whole fire fighting training system is supposed to be State funded, but it is not. Doug stated he has never been satisfied with the "rubber stamped" defensive driving course, which doesn't require any behind-the-wheel operation of a vehicle and stressed the importance of good orientation to different types of vehicles, regardless of sizes. He felt he could accomplish this in 16 hours, but would need funding to even do that and said he would wait to see what Tallahassee comes back with in April . - 6 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 He mentioned he wanted to make everyone aware that we have nothing concrete to look at and that even doing a cross-study on it would be frivolous . NON-EMERGENCY TRANSPORTATION: Doug said that Tallahassee was asking whether or not they need to govern non-emergency transport services, intending to add their own input to that received from different localities, which would then be forwarded to the board for submission to the governor as a committee . He further said he had no feeling about this one way or the other, since we have a local ordinance which covers it and from his personal observation, the strength of the local ordinance depends on the fact that state HRS does have a governing standard for wheel-chair vehicles and non-emergency transport vehicles which have to be met on a basic standard. If this would be removed, he said, we would additionally have to find our own ability to actually go out and inspect these people and drivers and make sure standards were maintained and this would not be financially advantageous to the locality. AIR-AMBULANCES : Doug said the air-ambulance laws were outdated before they were finished, one of the problems being that if all the conditions were met, there would be no place for the pilot to sit. He asked for input on the situation which would help the new Director, Larry Jordan, because State, at this point, is wondering whether or not they should even be involved in it. He mentioned that he had no input, since whenever he had needed an air-ambulance provider in the past, one of our own people had ridden with them and used our own equipment, so he had never had a problem. - 7 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 HIGH-HAZARD PAY FOR LOCAL GOVERNMENT: Stating this is a concern to anyone who wants to make a career out of being an EMT or paramedic, Doug mentioned that retirement systems vary from one locality to another, but thought it was about 35 years in the County. Neil Dorrill reported that the FL State Retirement System, of which this county and all non-chartered counties are eligible for, requires that an individual work at least 10 years before they become vested and have vested rights at a minimum level , with a host of provisions for early retirement beginning at age 55, and benefits can vary with different options available . He added that the average age of our work force is in the 20 's so 35 years is a good average number of years someone would have to work in order to receive retirement benefits. Doug 's concern was that new employees were coming into the system from the fire industry thinking the same benefits would apply, only to realize later they will retire at a lower scale and will have to work longer, adding that the injury rate is much higher . Explaining that Workmen' s Comp claims in EMS are outrageous relative to back injuries caused by falls, climbing rigs, grabbing equipment, and handling patients, he described the paramedic ' s role as a "young man 's sport" lasting as long as the back held out, and said that few people could start at age 20 and plan to retire in the field 35 years later. For this reason, he said, we should consider being classified similar to that of police and firefighters. Mr. Hill asked if police and firefighters received high-hazard pay. Doug replied that they were in a different category, which - 8 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 allows them to retire at an earlier age and also be eligible for different career benefits which we are ineligible for at this time. DPR vs HRS vs INSURANCE COMMISSIONERS : Doug reported that the Insurance Commissioner had not been included in the Auditor General 's final report to the legislature, and as far as they are concerned he is not their choice for licensing and certification but that he has apparently decided to take on the battle himself. He added that we are not getting into it at this time. A cost study done by DPR, Doug reported, showed a difference in the cost of licensing and certification alone to be approximately $400,000 more than charged by HRS for handling the whole program, which includes also governing it and inspecting it. Mr . Hill asked if this meant that HRS is more efficient, to which Mr. Greenfield answered, "No, the problem is their lack of efficiency. " Mr. Hill agreed that from his observation of HRS , he was not very much impressed . Dr. Ehrhardt asked what opinions had been received by Mr . Dorrill 's office reference input from EMSAC members . Billie Moyer reported that she had received only three (3) phone calls, one from Dr. Ehrhardt, who felt it should be left with HRS , and said he had found by reading that even HRS favored the transfer to DPR, feeling they are not in good enough shape to handle the program. Mr . Smelko called to say he felt it should be left as it is, and Mr . Akin had said we would be better off not to be a part of HRS, and favored DPR. SPECIAL TASK FORCE: Chief Ijams reported that work is continuing but he did not have any specific points to bring up at this time . He said the - 9 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 weekly meetings are running a little over 2 hrs and that Mr. Dorrill and the County Manager are still anticipated to attend the meeting of April 1st. He said Doug Greenfield had spent a hard 2 hrs with the force on two or three occasions and provided a lot of infor- mation the committee needed and appreciated. He reported that get- ting into every aspect of the study takes a lot of time but that things were progressing very well. Mr. Hill said the ultimate aim of the task force is to find out what we are doing, whether or not it is correct, and if it can be improved on or changed, and added that we have three outside "consul- tants" who are really superior in their knowledge of what we are seeking. He said that as Chairman of EMSAC, he was required by the By-laws to be a part of every sub-committee and has not missed a meeting so far. Mr. Dorrill was invited to attend whenever he is able, and it was made plain by Mr. Hill that anyone else who wished to attend was welcome. Norris Ijams referred to a concern for provisions related to the Sunshine Law and explained this as the reason the Chairman was announcing the sequence of meetings . Mr . Hill said he had talked to the County Attorney and that we had satisfied the Sunshine Law. Doug asked Mr . Hill to read the copy of the Workshop Agenda and make it available to other members to read, stating that the new HRS Director had addressed many complaints picked up from the State of Florida during the past year, evaluating each one and asking what had been done toward improvement. NEW BUSINESS VIAL OF LIFE: Mr. Greenfield introduced Mr. Wm. Beschen, who has donated - 10 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9 , 1983 several items of specialized equipment to EMS in the past to be used for training purposes including a quite expensive bio-manual blood pressure cuff and pulse monitoring device which is used in helicopter transports . Mr. Beschen and his wife have been interested in the Vial-of- Life program for several years and have improved on the procedure in many ways. Instead of the tube containing only limited infor- mation, which is to be taped or strapped with a rubber band inside your refrigerator, Mr. & Mrs . Beschen devised a tube which attaches firmly to the outside of the refrigerator with a magnet, and contains three (3) color-coded forms; #1 gives personal information, #2 con- tains medical information, and #3 contains information related to physician or hospital preference, request for Priest, minister or Rabbi, and a notarized authorization to allow EMS transport and stabilization. Two tubes are provided, one to be kept in the glove compartment of a car and the other on the refrigerator door . Stickers are included which go on the inside upper right-hand corner of the front door to alert EMT's to look for the tube on the refrigerator door. Mr. Beschen explained that he was not here to sell the County tubes, since he earns his living as a writer, but that this has simply been a pet project for him and his wife, who is a former EMT. He proposed to Doug that they provide tubes to high-schools, at cost, and the tubes then be promoted by the school children in a door-to- door effort. A set of tubes, magnets, instructions, 8 color-coded forms could be sold for $1 .50 , with 50 going for a band drive, uniforms, or whatever, and the other $1 . 00 going into a fund for _ 11 _ EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 EMS to be used for training programs, equipment, etc. Mr. Greenfield was very enthusiastic. COLLECTIONS UP AGAIN IN FEBRUARY: Jack Wampler reported that February was the best month we have had. Collections were $54 ,776, billings were $74 ,439. Percentage was 70 .3%, cumulative total 59 . 6% since April of 1981 . He mentioned that we had also participated in a survey with 15 other counties re billings and collections and we had matched or exceeded 11 of these counties . He reported our collection percentage to be about 63% since last October. Mr. Dorrill said that at this point, on a month-to-month basis, we are exceeding the anticipated revenues about 5 to 7% over what we had set for our goal. Mr . Hill said he always likes to keep up on collections because he is interested in proving to the Board that we are making an all out effort and don't have to ask the taxpayers for funds too often. COLLIER COUNTY TO BE HOST FOR FACEMS CONFERENCE : Doug reported that Collier County had been selected as the host for the 3rd quarter FACEMS conference this year in June and that he will be doing all the footwork in setting up for the event. He said the date has not been set, but that he is going to try for the Marriott on Marco and has sent flyers to members asking if they would like a particular topic to be included in the agenda for dis- cussion. He mentioned that a potential guest speaker was going to talk on either accounts receivable management or vehicle specifi- cations vs new federal specification guidelines . The Florida Associ- ation of County Emergency Medical-Services (FACEMS) meeting will last for three (3) days, and the organization encompasses 33 counties . - 12 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL March 9, 1983 EMS AMBULANCE INSPECTIONS : Ann Foster reported that the EMS ambulances have all had their mid-year inspections and had passed by either meeting or exceeding the standards . DR. TOBER UNABLE TO ATTEND MEETINGS : Chief Ijams recalled that a specific effort was to have been made to have Dr. Tober attend meetings and was informed by both Mr. Dorrill and Mr. Hill that in contacting Dr. Tober they found this to be next to impossible due to Dr . Tober 's busy schedule at the hospital. Chief Ijams said he has been in contact with Dr. Tober both by letter and telephone . MARCH 20-26 - EMS WEEK: Doug Greenfield mentioned that the Governor has announced that March 20-26 is EMS Week and that "Skip" Camp has already made arrange- ments to set up a display at Coastland Mall . Publicity will be given by both the news media and TV networks . APRIL MEETING: Meeting date will remain the second Wednesday of the month, at 4 :00 P.M. , in Room 144 until we can make better arrangements . The next meeting will be held on April 13 , 1983 . ADJOURNMENT There being no further business to come before the Council, the meeting was adjourned at 5 :40 P.M. MINUTES PREPARED BY: Billie Moyer Egon Hill, Chairman - 13 - DATE : March 2 , 1983 TO : EMSAC MEMBERS FROM: W . Neil Dorrill , Public Safety Administrator SUBJECT : NOTICE OF MARCH REGULAR MEETING Be advised that the next regular meeting of the Emergency Medical Services Advisory Council will be held on WEDNESDAY , March 9 , 1983 Bldg "F" - Room 144 4 : 00 P .M . If for any reason you will be unable to attend , please notify my office (774-8468) or Chairman Hill (261 -0569 ) so that your absence will be considered as excused . A REMINDER : The meeting day for the EMSAC has again been changed and will now be held on the second WEDNESDAY of the month . WND/bm Attachment : Agenda MEMORANDUM DATE: March 22, 1983 TO: EMSAC MEMBERS FROM: W. Neil Dorrill/Public Safety Administrator SUBJECT: Minutes of Meeting In accompaniment please find copy of Minutes of the regular meeting held on March 9 , 1983 . Please review these in order that they can be adopted at the next meet- ing to be held on Wednesday, April 13, 1983 at 4 : 00 P .M. in the Emergency Operations Center, Room 144 , in Bldg "F" . WND/bm cc : C. William Norman, County Manager Grace Spaulding/ Administrative Aide